Mehta N J, Khan I A, Mehta R N, Sepkowitz D A
Department of Medicine, Long Island College Hospital, Brooklyn, NY, USA.
Chest. 2000 Oct;118(4):1133-41. doi: 10.1378/chest.118.4.1133.
To report two new cases of HIV-related pulmonary hypertension and to review and analyze the existing reports on the subject.
Two new cases of HIV-related pulmonary hypertension are described, and the cases, case series, and related articles on the subject in all languages were identified through a comprehensive MEDLINE search.
Among the 131 reviewed cases, 54% were male, and the age range was 2 to 56 years (mean, 33 years). The interval between the diagnosis of HIV disease and the diagnosis of pulmonary hypertension was 33 months. In 82% of cases, pulmonary hypertension was related solely to HIV infection. Presenting symptoms were progressive shortness of breath (85%), pedal edema (30%), nonproductive cough (19%), fatigue (13%), syncope or near-syncope (12%), and chest pain (7%). The mean (+/- SD) pulmonary arterial systolic BP was 67 +/- 18 mm Hg (n = 116), and diastolic BP was 40+/-11 mm Hg (n = 39). Pulmonary vascular resistance was 983+/-420 dyne. s. cm(-5) (n = 29). Chest radiographs demonstrated cardiomegaly (72%) and pulmonary artery prominence (71%). Right ventricular hypertrophy was the most common electrocardiographic finding (67%). Dilatation of the right heart chambers was the most common echocardiographic finding (98%). Plexogenic pulmonary arteriopathy was the most common histopathology (78%). Pulmonary function tests demonstrated mild restrictive patterns with variably reduced diffusing capacities. The responses to vasodilator agents and antiretroviral therapy was variable. Sixty-six patients died during a median follow-up period of 8 months. The median length of time from diagnosis to death was 6 months.
HIV infection is an independent risk factor for the development of pulmonary hypertension. The appearance of unexplained cardiopulmonary symptoms in HIV-infected individuals should suggest pulmonary hypertension.
报告两例新的与人类免疫缺陷病毒（HIV）相关的肺动脉高压病例，并对该主题的现有报告进行回顾和分析。
描述两例新的与HIV相关的肺动脉高压病例，并通过全面的医学文献数据库（MEDLINE）检索确定了所有语言的该主题病例、病例系列及相关文章。
在131例回顾病例中，54%为男性，年龄范围为2至56岁（平均33岁）。HIV疾病诊断与肺动脉高压诊断之间的间隔为33个月。82%的病例中，肺动脉高压仅与HIV感染有关。主要症状为进行性气短（85%）、足部水肿（30%）、干咳（19%）、疲劳（13%）、晕厥或接近晕厥（12%）以及胸痛（7%）。肺动脉收缩压平均（±标准差）为67±18 mmHg（n = 116），舒张压为40±11 mmHg（n = 39）。肺血管阻力为983±420达因·秒·厘米⁻⁵（n = 29）。胸部X线片显示心脏扩大（72%）和肺动脉突出（71%）。右心室肥厚是最常见的心电图表现（67%）。右心腔扩张是最常见的超声心动图表现（98%）。丛状肺动脉病是最常见的组织病理学表现（78%）。肺功能测试显示轻度限制性模式，弥散能力不同程度降低。对血管扩张剂和抗逆转录病毒治疗的反应各不相同。66例患者在中位随访期8个月内死亡。从诊断到死亡的中位时间为6个月。
HIV感染是肺动脉高压发生的独立危险因素。HIV感染者出现无法解释的心肺症状应提示肺动脉高压。
